Individual
SHANNON DANIELLE FRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5789 CORDOVA RD, ERIE, IL 61250-9740
(863) 221-2351
Mailing address
5789 CORDOVA RD, ERIE, IL 61250-9740
(863) 221-2351
Taxonomy
Speciality
Code
Description
License number
State
163WP0000X
Pain Management Registered Nurse
209.025648
IL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
209.025648
IL
363LF0000X
Family Nurse Practitioner
A169408
IA
Other
Enumeration date
06/20/2022
Last updated
12/30/2024
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